Provider Demographics
NPI:1548747967
Name:BUZOLICH, AMANDA MARIE (AGPCNP-BC,OCN,CHPN,)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:BUZOLICH
Suffix:
Gender:F
Credentials:AGPCNP-BC,OCN,CHPN,
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MARIE
Other - Last Name:TALMADGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGPCNP-BC,OCN,CHPN
Mailing Address - Street 1:120 MINEOLA BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 MINEOLA BLVD STE 500
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4074
Practice Address - Country:US
Practice Address - Phone:516-663-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-27
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY713309-1163W00000X
NY9300321163W00000X
NY309947363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse